After a couple of decades in the market, I still hear that orthodontists avoid using clear aligner treatment because they can’t finish cases. Many doctors struggle with multiple additional aligner orders to get a satisfactory result. In contrast, others are looking for ways to improve their finishes as they grow their usage of clear aligners.
Proper digital treatment design is at the core of the best outcomes. For instance, by diagnosing effectively, implementing effective force systems, and detailing each case for improved finishes. Reflecting on the key ingredients for enhanced results, here are the five areas to focus on:
Final tooth positions
Otherwise known as Fi Pos, final tooth positions dictate the design of the aligner and the forces applied to the teeth. The positioning of teeth in the CAD software is critical for the desired outcome. Furthermore, it compensates for the system’s lag, challenging movements, and proper appliance design.
Resist the temptation to rely on the visual design to appease you of the appliance’s appearance. This will help achieve the results you want. Building in over treatments leads to sufficient aligners for the desired movements. Adding overcorrections can ensure we don’t undertake significant in-and-outs plus severe rotations.
Create space for alignment
A big challenge in finishing treatment comes from being unable to achieve proper alignment. Aligning teeth is a basic step to orthodontic treatment and can be missed due to improper treatment design. Teeth need appropriate forces, sufficient time, and space to move into the desired positions. Remember that a clear aligner is a closed tooth movement system. Similar to cinched archwires in a fixed appliance system. We must build in and proactively design space within the confines of the clear aligner appliance to satisfy the arch length necessary for the desired movements.
We don’t create enough space on many occasions, and teeth respond unfavorably. Some side effects include insufficient leveling of the curve of Spee, unexplained intrusions of single teeth, unfinished rotations, and posterior open bites. Whenever you see areas of significant crowding and overlap, add interdental spacing. You will be surprised how much your outcomes improve. Remember, difficult movements need more space than you think you need.
Finishing the occlusion
To sock in the occlusion is one area where many doctors struggle. Besides implementing proper final tooth positions and excellent leveling of the curve of Spee, I find that an additional aligner order designed to get better interdigitation is often needed to achieve a nice finish. When presented with moderate to mild posterior open bites, set up a series of aligners to sock in the occlusion by simultaneously extruding posterior teeth while they are retroclined. This movement improves the buccolingual inclination and takes advantage of a predictable extrusive movement.
Clear aligner adjuncts
For some challenging movements, using a combination of aligners with adjuncts can improve outcomes. Some of these adjuncts could include buttons for finishing elastics or combined use of fixed appliances with clear aligners. In cases with severe premolar rotations over 25 degrees, you should also consider bonded buttons with a power chain.
Smile esthetics
Regardless of the appliance, an orthodontist chooses for each patient’s treatment, there are key principles for improved finishes and esthetic results. When designing the treatment plan on a digital platform, continue to implement techniques to achieve the best smile arc, gingival contours, arch expansion, upper incisor inclination, and strategies to reshape teeth. Following these esthetic principles in a digital design will also help you achieve better finishes with clear aligner treatment.
